All About the 18-Month Well-Child Checkup

The 18-month checkup, along with all of your child's wellness appointments, is an important part of your child's healthcare. Your toddler may be due for some immunizations, and you might have lots of questions about things like sleep, discipline, and development milestones. Discover what typically happens at the 18-month well-child check and how to prepare so that you and your toddler get the most out of the session.

Growth Check and Physical Exam

During the 18-month check, your provider will examine your toddler and check on his growth and development. Here are some of the physical checks that may take place:

• Your toddler’s height, weight, and head circumference will be measured and recorded on standard growth charts your provider uses. These growth charts help track your toddler's development over time.

• Your little one’s eyes and ears may be checked.

• Your toddler’s provider might look inside his mouth to check on the gums and teeth.

• A stethoscope may be used to listen to the heart and lungs

• Your toddler may also be asked to walk a little, so your provider can check that his legs and feet move properly.

Screening Tests at the 18-Month Checkup

If your toddler has certain risk factors or is showing signs of a problem, your healthcare provider may recommend screening tests for things like

• anemia

• lead poisoning

• hearing issues

• vision problems

• autism

• developmental delays.

Your provider will talk you through which screening tests may be recommended and why, as well as what the next steps may be based on the results.

Immunizations Given at the 18-Month Checkup

Your toddler may get these shots at the 18-month checkup, or at a separate visit:

• The fourth dose of the DTaP vaccine

• The third dose of the polio vaccine

• The fourth dose of Hib

• The fourth dose of pneumococcus

• The second hepatitis A vaccine (if the first dose was given 6 months earlier).

Your toddler may also be given other immunizations if any were missed over the past few months. Your healthcare provider may also recommend a flu shot if your toddler hasn’t gotten one in the past year.

Topics That May Come Up at the 18-Month Visit

Your provider will use this visit to assess how your toddler is developing, and give you the information you need so that you feel more empowered as a parent. Your provider will be familiar with you and your family by now, and will tailor these discussions to your specific needs.

These are just some of the important topics that may come up at the 18-month visit:

Eating

Your provider may ask what and how much your child is eating these days. If you think your child is such a finicky eater that he isn't getting proper nutrition, talk it over with your provider.

You might like to ask whether your toddler needs any vitamin or fluoride supplements.

At this visit, you might also like to ask about healthy snack ideas, pick up some tips on getting your 18-month-old to try new foods, and find out how to feed your toddler if he prefers wriggling and playing to eating.

You might be asked if your toddler can use a spoon and drink from a cup, and whether your toddler is still taking a bottle.

If you are still breastfeeding but would like to stop soon, your provider can also offer tips on weaning.

Sleeping

Your healthcare provider may ask how well your child is sleeping at night and whether he is having one or two daytime naps. It might help to keep a diary of your child's sleeping patterns for a few days and bring it to the visit.

If it’s needed, your healthcare provider can offer some guidance on how to improve your little one’s sleep routine, and how to settle your little one if he wakes at night.

Potty Training Readiness

Your healthcare provider might ask you about whether you’re seeing any signs of readiness for potty training, and may offer advice on when and how to introduce the potty.

Let the provider know if your child has diarrhea or is constipated, and feel free to bring up any concerns you may have.

Development Milestones

How your child plays and behaves gives your healthcare provider lots of information about how he’s progressing. Having this information helps your provider recommend additional support or steps to help ensure your toddler’s healthy development.

Each visit is unique, and your provider knows your family best, but these are some examples of questions your healthcare provider may ask about your toddler’s development:

• How are your child's walking and climbing skills?

• Can your toddler say several single words, and shake his head as if to say “no”?

• Does he understand one-step commands such as "Get your shoes" or "Bring me a diaper"?

• Can he point to the right body part when asked?

• Does he imitate you in things you often do, such as by feeding a doll or holding a phone to the side of his head?

• How does he play? Can he pull a toy along the ground? Does he scribble?

• Does he point to show what he wants or to get your attention? Does he like to hand objects to people?

• Is he afraid of strangers, but shows affection to people he knows well?

Remember, your toddler is unique and develops at his own pace. He may reach some milestones earlier or later than other children. It’s important that your provider get an accurate picture of where your child is at now in order to support healthy development.

You can read more about your toddler’s development milestones in our month-by-month toddler development series.

Behavior

Your healthcare provider may ask you about your toddler’s behavior and about your discipline strategies—what works and what doesn't.

Your toddler's growing sense of independence could be leading to him acting out and misbehaving in various ways. "No" might be your toddler’s favorite word.

Let your provider know if you’re facing any challenges. Your provider has lots of experience and will be able to give you some pointers on how to set up age-appropriate rules and boundaries, and how to handle issues that could arise as your toddler approaches the “terrible twos,” which are just around the corner.

Recent Health Issues

Your healthcare provider may want to know if your child has seen another healthcare provider since the last visit. The provider may ask about any outcomes of that visit, and if any medications or treatments were prescribed.

Your provider may also ask if you have any other current concerns about your toddler’s health.

Other Topics Your Healthcare Provider Might Talk to You About

Your toddler’s healthcare provider knows your situation and might raise several other topics that could be relevant to you at this stage. Generally speaking, here are some other things that may come up at the 18-month check:

• How to choose a preschool

• Dealing with separation anxiety

• Oral hygiene and how to care for your toddler’s teeth and gums

• Any infections that are making the rounds in your area now

• Safety tips, especially as your toddler becomes more mobile, curious, and independent

• Any outside support or resources that may be available to you and your family to help ensure the happy and healthy development of your toddler

• Introducing your toddler to your new baby, if you are pregnant again, or dealing with sibling rivalry if you already have more than one child.

Ask Any Questions You Have

From time to time you might have questions that aren’t necessarily urgent. Write these down as you go and have them with you at this well-child visit. Here are some of things you may be curious about, for example:

• What’s an effective way to discipline an 18-month-old?

• How much and what kind of screen time can your 18-month-old have?

• Are there certain foods to avoid serving? (For example, you may be worried about an allergic reaction to something specific.)

• What to do if you are struggling to wean your little one from the breast or bottle?

• What should you do if you need to toilet train your little one by age 2 (for example, if your chosen preschool requires it)?

• Should you be stopping the morning nap soon?

• Is it OK if your 18-month-old doesn’t want to nap at all?

• Is it OK if your little one is shy around other toddlers?

• How can you encourage your toddler’s language development?

• How can you make the daycare drop-off easier?

• Can the provider recommend a great pediatric dentist in the area (if you don't already have one)?

Let Your Healthcare Provider Know If…

• Your child can’t walk yet or is always walking on her toes

• Your child doesn’t mimic the way you use familiar household objects like the phone or cup

• Your child can’t say several words

• Your child doesn’t show affection to close family members

• Your child doesn’t seem to notice when you or any other caregiver leaves or returns

• Your child loses a skill she once had

• You have any other issues, questions, or concerns about your toddler’s development or your life as a parent.

Tips for the Visit

You probably know now from experience what works for you for these visits, but here are some general tips:

• Ensure your toddler isn’t over-tired or hungry

• Dress your toddler in a two-piece outfit that comes off easily for the physical exam

• Pack some snacks

• Pack a toy or two to keep her entertained

• Take any medical documents your provider doesn’t have, and write down any questions or observations you have so you don’t forget anything

• Plan to go with someone, if you can. It might help you to focus on your conversation with your provider if your partner, a grandparent, or a friend is there with your little one.

• Make the visit a treat. For example, you might like to follow the visit with an ice cream cone or a trip to the playground so that your little one associates something fun with the visit as well.

The Bottom Line

Time flies, doesn’t it? Just a moment ago you were celebrating your baby’s first birthday, and now it’s already time for the 18-month checkup. Remember, these visits are for your and your toddler’s benefit. They are a great chance to see how your little one is developing and to get answers to any questions you have. Your toddler is unique, and nothing can replace receiving personalized advice from an expert, and building a relationship with a trusted healthcare provider over time.

Your next routine visit will be in six months, so why not look ahead and read up on the 2-year-old well-child visit.